Fax Back Order Form
TO: 9650 Rockville Pike
Bethesda, MD 20814-3998
Phone: 301-634-7157
Fax: 301-634-7153
Date: ____________________ Purchase Order No.
____________________
FROM:
Advertiser: ________________________________________________
Address: __________________________________________________
City, State, Zip: ____________________________________________
Phone: ____________________________________________________
Fax: ______________________________________________________
___YES, Please Reserve the Following!
Publication:__________________________________
Space Rate:_______________
Publication Date (M/Y):_______
Color Rate:_________ Frequency Rate:_________ Special Position
Rate:_________
Ad Color:________
Ad Size: (FP)_______ 1/2 Pg. (Hor)_______ 1/2 Pg. (Vert)________
1/4 Pg.________
Less Agency Discount: _____________________________
Ad Title:_______________________________________________
Position:________________________________
Material Instructions:________________________________________________
Total:______________________
Send Invoice & 2 Tear Sheets to:
_____________________________________________
_____________________________________________
_____________________________________________
Authorized Signature_______________________________________________________
Date__________________
_____ Please contact me about advertising in the APS online journals.
____ Please send me information on Sustaining Associate Membership in the
APS.
Before completing your order request, make sure you've considered
these savings options!
You receive placement credits based on insertions regardless of which APS
or AdNet publication you select...
For example:
1 placement in AJP:Cell Physiology
2 placements in AJP: Endocrinology & Metabolism
1 placement in Journal of Applied Physiology
1 placement in The FASEB Journal
1 placement in Journal of Biological Chemistry
= 6 placements which entitles you to a 6x insertion order rate for EACH
publication
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